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Case Detection Testing for Primary Aldosteronism in Male Patients with Hypertension and Snoring

Abstract

Menghui Wang, Nanfang Li, Ying Zhang, Delian Zhang, Suofeiya Abulikemu, Yinchun Wang, Guli Nuer, Jianqiong Kong, Juhong Zhang, Zhitao Yan1, Hongjian Li, and Xiangyang Zhang

Objectives: Coexistence of primary aldosteronism and obstructive sleep apnea in hypertension is evidenced. However, aldosterone and renin activity is varying with apnea/hypopnea index changes in subjects with resistant hypertension. Thus, the aim is to investigate the optional cutoff value for aldosterone/renin activity to screen primary aldosteronism in patients with different status of apnea/hypopnea index.

Methods: 271 hypertensive male snores were evaluated via polysomnography and divided into two groups, group with apnea/hypopnea index >15 events/h and with apnea/hypopnea index <15 events/h. Primary aldosteronism was determined as following: subjects with plasma renin activity<1.0 ng/mL/h and aldosterone concentration>15 ng/dL performed saline infusion test, after which aldosterone concentration>5 ng/dL was a sign of primary aldosteronism. Receiver operating characteristic curve was applied to explore appropriate cutoff value for aldosterone/renin activity.

Results: 39 (14.4%) of the 271 were diagnosed with primary aldosteronism including 15 with apnea/hypopnea index <15 events/h and 24 with apnea/hypopnea index >15 events/h. Area under receiver operating characteristic curve was 0.97 (95%CI 0.94-0.99) in the group with apnea/hypopnea index >15 events/h and 0.91 (95%CI 0.87-0.96) in the group with apnea/hypopnea index <15 events/h. Appropriate cutoff value for aldosterone/renin activity is 29.1 ng/dL per ng/mL/h for the group with apnea/hypopnea index <15 events/h with sensitivity 100%, specificity 90% and 15.9 ng/dL per ng/mL/h for the group with apnea/hypopnea index >15 events/h with sensitivity 100%, specificity 69.7%. Youden index is 0.9 for the group with apnea/hypopnea index <15 events/h and 0.7 for the group with apnea/hypopnea index >15 events/h.

Conclusions: Optional cutoff values of aldosterone/renin activity to screening for primary aldosteronism should be considered in patients with different status of apnea/hypopnea index.